Hold the Hors d'Oeuvres

For doctors, the continuing education credits required by most states to renew a medical license are a way to bone up on the latest clinical developments while chowing down at some of the country's finest restaurants. For drug companies, which provide much of the more than $1.7 billion spent annually on these dinner meetings and conferences, they are an opportunity to help educate physicians who must remain up-to-date in a rapidly changing field.

But some doctors have complained that industry sponsorship of medical education creates an inherent conflict of interest for physicians at the expense of patients who risk being prescribed drugs they may not need or cannot afford.

"If you're a doctor, you can refuse to see drug reps in your office, but you can't avoid CMEs," said physician Adriane Fugh-Berman, a longtime critic of industry funding of continuing medical education programs. While these courses appear impartial, said Fugh-Berman, an associate professor in the department of physiology at Georgetown University School of Medicine, they can be an integral but largely unscrutinized part of a covert marketing campaign to convince doctors that a disease or condition is pervasive, under-diagnosed and best treated by writing a prescription.

Two weeks ago, armed with a $400,000 grant, Fugh-Berman and several Georgetown colleagues launched PharmedOut, a free, Internet-based alternative for doctors seeking CME courses devoid of industry funding. The site ( http://www.pharmedout.org) lists more than 200 online classes available to doctors at no cost, many of them sponsored by federal agencies such as the Food and Drug Administration and the National Institutes of Health. It also includes links to studies exploring the role of drug company funding in medical education and research, as well as a YouTube interview with a former drug salesman who candidly discusses the ways he deflected doctors' concerns about a widely prescribed psychiatric drug that has been linked to massive weight gain and diabetes.

PharmedOut is one of about two dozen projects across the country designed to teach doctors and nurses to critically evaluate information about drugs and to direct them to unbiased information. The projects are funded by a $21 million grant through the Attorney General Consumer and Prescriber Grant Program, which was created as part of a 2004 settlement by Warner-Lambert involving the drugmaker's illegal promotion of the widely used epilepsy drug Neurontin.

The second phase of the program, which is being administered by the Center for Evidence-Based Policy at the Oregon Health & Science University, will provide similar educational programs targeted at consumers.

Interest in the overt and covert ways drug companies influence doctors has mushroomed in the past few years, experts say, fueled in part by concerns about the safety of prescription drugs, exemplified by the now-withdrawn blockbuster pain medication Vioxx, coupled with the skyrocketing cost of pharmaceuticals. Much of the attention has focused on the influence of salespeople who frequent doctors' offices touting new medicines, dropping off free samples and buying lunch for the staff.

More recently there has been debate about drug companies' influence on the outcome of scientific studies it finances, and on medical education, including residency training programs.

Scott Lassman, senior assistant general counsel of the pharmaceutical trade group PhRMA, said that drug manufacturers do not wield undue influence in continuing education because the content of CME courses is "completely independent" and not designed or dictated by drug companies.

Firms "fund it because they feel it is an important part of medical education," Lassman said, and are fulfilling "a corporate responsibility" by bankrolling courses.

There is no dispute that CMEs are big business. According to the Accreditation Council for Continuing Medical Education, which oversees the courses, more than $1.7 billion was spent on CME programs in 2005, more than double the $842 million reported in 1998.

About $1 billion comes from drug companies, Fugh-Berman noted in an article posted last year in Virtual Mentor, an online ethics journal published by the American Medical Association.